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Orozco-Beltrán D, Carratalá-Munuera C, Arriero JM, Campo P, Martínez-Moragón E, Molina J, Quintano-Jiménez JA, Gil-Guillén VF. Management and referral of patients with severe and poorly controlled asthma in primary care. Fam Pract 2016; 33:678-683. [PMID: 27543792 DOI: 10.1093/fampra/cmw081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Over 50% of treated patients with asthma in Europe are not well controlled. Their management in primary health care (PHC) differs from that in specialized care, and there is no real coordination between the two. OBJECTIVES To identify barriers and solutions to improving the management of patients with severe and poorly controlled asthma and the communication between specialists and PHC, and to reach a consensus on the criteria for referral patients. METHODS An observational study using a modified Delphi technique. About 79 physicians from PHC, pneumology and allergy fields from different Spanish regions were invited to participate via an online questionnaire. Consensus was reached on an item when more than two-thirds of the panel members scored within the 3-point category (1-3 or 7-9) containing the median and the interquartile range of answers had to be ≤4 points. RESULTS Response rate: 52%. After the second round, consensus items were 40 (62.5%): of which 37 in agreement and 3 in disagreement. Around 92.68% of respondents agreed that it would be useful to incorporate questionnaires for asthma control into PHC computer-based searches. About 100% of participants agreed that clear consensus criteria between PHC and specialists must be determined to decide when a patient with asthma is referred from PHC to specialist or vice versa. Ten of the proposed criteria reached consensus agreement. CONCLUSION The failure to use guidelines and specific questionnaires for asthma control in PHC is one reason why there is underdiagnosis and poor control of asthma. Some strategies to improve the asthma care management emerged from the survey results.
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Affiliation(s)
| | | | - Juan M Arriero
- Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Alicante, Spain
| | - Paloma Campo
- Allergology Division, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Jesús Molina
- Primary Care Center, Centro de Salud Francia, Fuenlabrada, Madrid, Spain and
| | | | - Vicente F Gil-Guillén
- Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Alicante, Spain
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Gardner A, Kaplan B, Brown W, Krier-Morrow D, Rappaport S, Marcus L, Conboy-Ellis K, Mullen A, Rance K, Aaronson D. National standards for asthma self-management education. Ann Allergy Asthma Immunol 2015; 114:178-186.e1. [PMID: 25744903 DOI: 10.1016/j.anai.2014.12.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 12/15/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Asthma education reimbursement continues to be an issue in the United States. Among the greatest barriers is the lack of a standardized curriculum for asthma self-management education recognized by a physician society, non-physician health care professional society or association, or other appropriate source. The applicable Current Procedural Terminology codes for self-management education and training are 98960 through 98962, stating that "if a practitioner has created a training curriculum for educating patients on management of their medical condition, he or she may employ a non-physician health care professional to provide education using a standardized curriculum for patients with that disease." Without a standardized curriculum, reimbursement from payers is beyond reach. OBJECTIVE Representatives from the Joint Council of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; American Academy of Allergy, Asthma, and Immunology; American Lung Association; American Thoracic Society; National Asthma Educator Certification Board; American College of Chest Physicians; and Association of Asthma Educators gathered to write a standardized curriculum as a guideline for payer reimbursement. METHODS The Task Force began with a review of the American Lung Association and American Thoracic Society's Operational Standards for Asthma Education. Board members of the National Asthma Educator Certification Board incorporated comments, rationale, and references into the document. RESULTS This document is the result of final reviews of the standards completed by the Task Force and national health care professional organizations in September 2014. CONCLUSION This document meets the requirements of Current Procedural Terminology codes 98960 through 98962 and establishes the minimum standard for asthma self-management education when teaching patients or caregivers how to effectively manage asthma in conjunction with the professional health care team.
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Affiliation(s)
| | | | - Wendy Brown
- Association of Asthma Educators, Columbia, South Carolina
| | | | | | - Lynne Marcus
- American College of Allergy, Asthma, and Immunology, Arlington Heights, Illinois
| | - Kathy Conboy-Ellis
- American College of Allergy, Asthma, and Immunology, Arlington Heights, Illinois
| | - Ann Mullen
- Association of Asthma Educators, Columbia, South Carolina
| | - Karen Rance
- National Asthma Educator Certification Board, Gilbert, Arizona.
| | - Donald Aaronson
- Joint Council of Allergy, Asthma, and Immunology, Palatine, Illinois
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Peytremann‐Bridevaux I, Arditi C, Gex G, Bridevaux P, Burnand B. Chronic disease management programmes for adults with asthma. Cochrane Database Syst Rev 2015; 2015:CD007988. [PMID: 26014500 PMCID: PMC10640711 DOI: 10.1002/14651858.cd007988.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The burden of asthma on patients and healthcare systems is substantial. Interventions have been developed to overcome difficulties in asthma management. These include chronic disease management programmes, which are more than simple patient education, encompassing a set of coherent interventions that centre on the patients' needs, encouraging the co-ordination and integration of health services provided by a variety of healthcare professionals, and emphasising patient self-management as well as patient education. OBJECTIVES To evaluate the effectiveness of chronic disease management programmes for adults with asthma. SEARCH METHODS Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register, MEDLINE (MEDLINE In-Process and Other Non-Indexed Citations), EMBASE, CINAHL, and PsycINFO were searched up to June 2014. We also handsearched selected journals from 2000 to 2012 and scanned reference lists of relevant reviews. SELECTION CRITERIA We included individual or cluster-randomised controlled trials, non-randomised controlled trials, and controlled before-after studies comparing chronic disease management programmes with usual care in adults over 16 years of age with a diagnosis of asthma. The chronic disease management programmes had to satisfy at least the following five criteria: an organisational component targeting patients; an organisational component targeting healthcare professionals or the healthcare system, or both; patient education or self-management support, or both; active involvement of two or more healthcare professionals in patient care; a minimum duration of three months. DATA COLLECTION AND ANALYSIS After an initial screen of the titles, two review authors working independently assessed the studies for eligibility and study quality; they also extracted the data. We contacted authors to obtain missing information and additional data, where necessary. We pooled results using the random-effects model and reported the pooled mean or standardised mean differences (SMDs). MAIN RESULTS A total of 20 studies including 81,746 patients (median 129.5) were included in this review, with a follow-up ranging from 3 to more than 12 months. Patients' mean age was 42.5 years, 60% were female, and their asthma was mostly rated as moderate to severe. Overall the studies were of moderate to low methodological quality, because of limitations in their design and the wide confidence intervals for certain results.Compared with usual care, chronic disease management programmes resulted in improvements in asthma-specific quality of life (SMD 0.22, 95% confidence interval (CI) 0.08 to 0.37), asthma severity scores (SMD 0.18, 95% CI 0.05 to 0.30), and lung function tests (SMD 0.19, 95% CI 0.09 to 0.30). The data for improvement in self-efficacy scores were inconclusive (SMD 0.51, 95% CI -0.08 to 1.11). Results on hospitalisations and emergency department or unscheduled visits could not be combined in a meta-analysis because the data were too heterogeneous; results from the individual studies were inconclusive overall. Only a few studies reported results on asthma exacerbations, days off work or school, use of an action plan, and patient satisfaction. Meta-analyses could not be performed for these outcomes. AUTHORS' CONCLUSIONS There is moderate to low quality evidence that chronic disease management programmes for adults with asthma can improve asthma-specific quality of life, asthma severity, and lung function tests. Overall, these results provide encouraging evidence of the potential effectiveness of these programmes in adults with asthma when compared with usual care. However, the optimal composition of asthma chronic disease management programmes and their added value, compared with education or self-management alone that is usually offered to patients with asthma, need further investigation.
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Affiliation(s)
- Isabelle Peytremann‐Bridevaux
- Lausanne University HospitalCochrane Switzerland, Institute of Social and Preventive MedicineBiopôle 2Route de la Corniche 10LausanneSwitzerlandCH‐1010
| | - Chantal Arditi
- Lausanne University HospitalCochrane Switzerland, Institute of Social and Preventive MedicineBiopôle 2Route de la Corniche 10LausanneSwitzerlandCH‐1010
| | - Grégoire Gex
- Hôpital du ValaisService de PneumologieSionSwitzerland
| | | | - Bernard Burnand
- Lausanne University HospitalCochrane Switzerland, Institute of Social and Preventive MedicineBiopôle 2Route de la Corniche 10LausanneSwitzerlandCH‐1010
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Hisashige A. The effectiveness and efficiency of disease management programs for patients with chronic diseases. Glob J Health Sci 2012; 5:27-48. [PMID: 23445693 PMCID: PMC4776791 DOI: 10.5539/gjhs.v5n2p27] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 11/18/2012] [Indexed: 11/17/2022] Open
Abstract
Objective: Disease management (DM) approach is increasingly advocated as a means of improving effectiveness and efficiency of healthcare for chronic diseases. To evaluate the evidence on effectiveness and efficiency of DM, evidence synthesis was carried out. Methods: To locate eligible meta-analyses and systematic reviews, we searched Medline, EMBASE, the Cochrane Library, SCI-EXPANDED, SSCI, A&HCI, DARE, HTA and NHS EED from 1995 to 2010. Two reviewers independently extracted data and assessed a study quality. Results: Twenty-eight meta-analyses and systematic reviews were included for synthesizing evidence. The proportion of articles which observed improvement with a reasonable amount of evidence was the highest at process (69%), followed by health services (63%), QOL (57%), health outcomes (51%), satisfaction (50%), costs (38%) and so on. As to mortality, statistically significant results were observed only in coronary heart disease. Important components in DM, such as a multidisciplinary approach, were identified. Conclusion: The evidence synthesized shows considerable evidence in the effectiveness and efficiency of DM programs in process, health services, QOL and so on. The question is no longer whether DM programs work, but rather which type or component of DM programs works best and efficiently in the context of each healthcare system or country.
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Yang J. Systematical Analysis of the Application of Chinese Traditional Medicine Informatics to Diabetes Proved Recipesw. ACTA ACUST UNITED AC 2012. [DOI: 10.7243/2050-0866-1-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gillani SW, Sulaiman SAS, Sundram S, Victor SC, Abdullah AH. Clinical critics in the management of diabetes mellitus. Health (London) 2012. [DOI: 10.4236/health.2012.48085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Ungar WJ, Paterson JM, Gomes T, Bikangaga P, Gold M, To T, Kozyrskyj AL. Relationship of asthma management, socioeconomic status, and medication insurance characteristics to exacerbation frequency in children with asthma. Ann Allergy Asthma Immunol 2010; 106:17-23. [PMID: 21195940 DOI: 10.1016/j.anai.2010.10.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 09/28/2010] [Accepted: 10/03/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND less than 25% of asthmatic children are well controlled. OBJECTIVE to identify factors associated with asthma exacerbation causing emergency department (ED) visits or hospitalizations related to health status, socioeconomic status (SES), and drug insurance. METHODS in this retrospective cohort study, complete data were collected on 490 asthmatic children regarding demographics, SES, drug plan characteristics, health status, health resource use, and symptoms. Interview data were linked to administrative data on asthma ED visits and hospitalizations occurring in the following year. Multiple Poisson regression identified independent variables associated with ED visits or hospitalizations in the full cohort and in a subgroup with prescription drug insurance. RESULTS younger age, previous emergency visits, nebulizer use, pet ownership, and receipt of asthma education but not an action plan were significantly associated with more frequent exacerbations. In the full cohort, children with high income adequacy had 28% fewer exacerbations than did children with low income adequacy. In the subgroup with drug insurance, girls had 26% fewer exacerbations than did boys, and children with food, drug, or insect allergies had 52% more exacerbations than did children without allergies. Children of families with annual insurance deductibles greater than $90 had 95% fewer exacerbations. Every percentage increase in the proportion of income spent out-of-pocket on asthma medications was associated with a 14% increase in exacerbations. CONCLUSIONS asthma history, disease management factors, and SES were associated with exacerbations requiring urgent care. In families with drug plans, the magnitude of asthma medication cost-sharing as a proportion of household income, rather than income alone, was significantly associated with exacerbations.
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Affiliation(s)
- Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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[Economic aspects of severe asthma]. Presse Med 2007; 37:117-28. [PMID: 18037259 DOI: 10.1016/j.lpm.2007.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 05/31/2007] [Accepted: 06/01/2007] [Indexed: 11/23/2022] Open
Abstract
Severe asthma and difficult-to-treat asthma are major issues in public health, given the mortality and morbidity they induce and their detrimental effects on patients' quality of life. The economic consequences should not be overlooked either. Published studies suggest that asthma-related medical resource use increases with the degree of asthma severity. Medical resource use incurred by severe (and/or difficult-to-treat) asthma could be reduced in part by more appropriate treatment, better patient education, improved coordination of disease management and treatment of comorbid diagnoses. The specific difficulties in the management of severe asthma and/or difficult-to-treat asthma must nonetheless be kept in mind. Recent new treatments appear promising, but their costs and indications in actual medical practice require better definition.
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Polisena J, Tam S, Lodha A, Laporte A, Coyte PC, Ungar WJ. An economic evaluation of asthma action plans for children with asthma. J Asthma 2007; 44:501-8. [PMID: 17885851 PMCID: PMC4940172 DOI: 10.1080/02770900701495728] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The costs and effectiveness of asthma action plans for children were evaluated in a cross-sectional economic analysis. Direct health care and indirect costs, nights with symptoms, and asthma attacks were measured in 879 Ontario children with asthma. From a societal perspective, the total annual costs of the asthma action plan and the control groups were CDN$6,948 and CDN$6,140 per patient, respectively. Health outcomes were similar. The difference in cost was attributable to greater medication and health services use in the intervention group. Prospective randomized trials are necessary to measure potential improvements in control of asthma using asthma action plans.
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Affiliation(s)
- Julie Polisena
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Susanna Tam
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Abhay Lodha
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Audrey Laporte
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Peter C. Coyte
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Faculty of Nursing, University of Toronto, Toronto, Canada
- Canadian Health Services Research Foundation/Canadian Institutes for Health Research Health Services Chair, University of Toronto, Toronto, Canada
- Health Care, Technology and Place Canadian Institutes for Health Research Strategic Training Program, Toronto, Canada
| | - Wendy J. Ungar
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Program of Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
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Uhl K, Trontell A, Kennedy D. Risk minimization practices for pregnancy prevention: understanding risk, selecting tools. Pharmacoepidemiol Drug Saf 2006; 16:337-48. [PMID: 16953517 DOI: 10.1002/pds.1312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
According to the March of Dimes, approximately 4% (1/28) of babies are born in the US each year with a birth defect. For the majority of birth defects the etiology is unknown, although chemicals, including drug exposures, probably account for less than 1% of all birth defects. The identification of potential human teratogenicity during drug development is important because drug-induced adverse fetal effects are potentially preventable with the application of risk assessment strategies and risk minimization tools and programs to minimize risk of pregnancy exposure while preserving access to drug benefits; risk assessment and risk minimization together comprise risk management. It is important that risk minimization programs intended to limit fetal exposure use a consistent approach and are tailored to the product-specific risk concerns in order to optimize the benefit-risk balance for a particular drug. This paper highlights general considerations in developing specific risk minimization programs to prevent fetal drug exposure including the relative advantages and disadvantages of each strategy.
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Affiliation(s)
- Kathleen Uhl
- US Food and Drug Administration, Office of Women's Health, Rockville, MD 20857, USA.
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